Dobutamine: A hemodynamic evaluation in pulmonary embolism shock

Jardin, François; Genevray, Bruno; Brun‐Ney, D.; Margairaz, A

doi:10.1097/00003246-198512000-00004

Cited by 111 publications

(30 citation statements)

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“…Case reports and case series related to massive pulmonary embolism have utilized various agents such as dopamine, norepinephrine, epinephrine, levosimendan and dobutamine, without the ability to make strong suggestions for care. [33][34][35] The largest study is an observational review of 87 patients with pulmonary embolism in whom the use of norepinephrine or epinephrine was associated with worse ICU outcome, but no alternatives to treatment of the obstructive shock are offered. 36 Studies addressing cardiac tamponade are also not able to offer strong treatment suggestions.…”

Section: Statement: Epinephrine Increases Metabolic Abnormalities Commentioning

confidence: 99%

Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

Djogovic

MacDonald

Wensel

et al. 2015

CJEM

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Section: Statement: Epinephrine Increases Metabolic Abnormalities Commentioning

confidence: 99%

Vasopressor and Inotrope Use in Canadian Emergency Departments: Evidence Based Consensus Guidelines

Djogovic

MacDonald

Wensel

et al. 2015

CJEM

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“…4 The recommendations of Schmidt and Wood 4 which prompted the authors to try inotropic therapy with ephedrine are based primarily on experiments in animal models of pulmonary embolism (exemplified by the work published by Prewitt's laboratory 7 , 8 ) and clinical studies in patients with pulmonary thromboembolism. 9 As the availability of TEE in the operating room increases, we expect that more information concerning the human pathophysiological consequences of acute venous air embolism and its treatment will be reported.…”

Section: Discussionmentioning

confidence: 99%

Successful management of venous air embolism with inotropic support

Archer

Pash

MacRae

2001

Can J Anesth/J Can Anesth

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204Purpose: Since venous air embolism may occur during many different types of surgery, management of this clinical emergency can be required in patients who do not have a previously established central venous access for aspiration of air. Recent reviews suggest that management of right heart syndromes in patients with embolism is critical in improving outcome.Clinical Features: Abrupt decreases in oxygen saturation (from 98% to 40%) and end-tidal carbon dioxide tension (from 24 to 6 mm Hg), compatible with venous air embolism were observed in a 73-yr-old woman during craniotomy for meningioma in the supine position. Since no access for aspiration of air was readily available, therapy was directed at inotropic support of the right heart using a bolus of ephedrine. Cardiorespiratory variables rapidly returned to normal, and the patient recovered from anesthesia and surgery without sequelae.Conclusions: Venous air embolism places an acute load on the right ventricle and may provoke right heart failure, even in the absence of total cardiovascular collapse. Treatment that supports right heart function may allow sufficient time for redistribution of embolized air and produce a good outcome when access for central aspiration of air is not available.Objectif : Comme l'embolie gazeuse veineuse peut survenir pendant de nombreuses interventions chirurgicales de type différent, le traitement de cette urgence clinique peut être nécessaire chez des patients qui n'ont pas d'accès veineux central préétabli pour l'aspiration de l'air. Des révisions récentes suggèrent que le traitement des syndromes du coeur droit soit crucial pour l'évolution favorable des patients qui présentent une embolie.Éléments cliniques : La baisse brutale de la saturation en oxygène (de 98 % à 40 %) et de la pression de fin d'expiration du gaz carbonique (de 24 à 6 mmHg), compatibles avec une embolie gazeuse veineuse, ont été observés chez une femme de 73 ans pendant une craniotomie pour l'ablation d'un méningiome, en décubitus dorsal. Aucun accès pour l'aspiration de l'air n'étant rapidement disponible, la thérapie a consisté en une assistance inotrope du coeur droit en utilisant un bolus d'éphédrine. Les variables cardiorespiratoires sont revenues rapidement à la normale et la patiente a connu une récupération anesthésique et chirurgicale sans séquelles.Conclusion : L'embolie gazeuse veineuse provoque une brusque surcharge du ventricule droit et peut entraî-ner une défaillance du coeur droit, même en l'absence de collapsus cardiovasculaire. Le traitement qui consiste en un soutien de la fonction du coeur droit peut laisser suffisamment de temps pour la redistribution de l'air embolisé et donner un bon résultat lorsque l'accès veineux central pour l'aspiration de l'air n'est pas disponible.

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“…However, their use can have implications for the increased preload that peripheral vasoconstriction causes for those reasons explained above in terms of worsening RV compliance. As for inotropy, Dobutamine increases myocardial contractility and while causing vasodilation (decreased afterload) is ideal for cardiogenic shock; however the impact of vasodilation can exceed that of increased myocardial contractility which may worsen the hypotension (DiPiro et al, 2005;Jardin et al, 1985). Therefore, consistent with our current practice we opted for combined therapy using dobutamine plus noradrenaline; this permitted increased myocardial contractility while minimizing both vasodilatory effects and the inherent risk of hypotension associated with its use, but also mindful of RV function and its relation to increased venous return caused by the noradrenaline.…”

Section: Managementmentioning

confidence: 99%